nach oben

Erschienen in:

01.03.2014 | Original Article

Postpartum translabial 2D and 3D ultrasound measurements of the anal sphincter complex in primiparous women delivering by vaginal birth versus Cesarean delivery

verfasst von: Kate V. Meriwether, Rebecca J. Hall, Lawrence M. Leeman, Laura Migliaccio, Clifford Qualls, Rebecca G. Rogers

Erschienen in: International Urogynecology Journal | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

Consensus on normal translabial ultrasound (TL-US) anal sphincter complex measurements for postpartum women is lacking. We aimed to evaluate normative measurements in 2D and 3D TL-US for the anal sphincter complex (ASC) at 6 months postpartum and compare these measurements in women who had a vaginal birth (VB) and in those who had a Cesarean delivery (CD).

Methods

A large, prospective cohort of primiparous women underwent 2D and 3D TL-US 6 months after their first delivery. For normative sphincter measurements, we excluded women with third- or fourth-degree lacerations or with sphincter interruption on TL-US. Measurements included the sphincter thickness at the 3, 6, 9, and 12 o’clock positions of the external anal sphincter (EAS) and the internal anal sphincter (IAS) at proximal, mid, and distal levels. We also measured the mean coronal diameter of the pubovisceralis muscle (PVM).

Results

696 women consented to participate, and 433 women presented for ultrasound imaging 6 months later. Women who sustained a third- or fourth-degree laceration had significantly thicker EAS measurements at 12 o’clock. Sphincter asymmetry was common (69 %), but was not related to mode of delivery. Only IAS measurements at the proximal and distal 12 o’clock position were significantly thicker for CD patients. There were no significant differences in the EAS or PVM measurements between VB and CD women.

Conclusions

There appear to be few differences in normative sphincter ultrasound measurements between primiparous patients who had VB or CD.

DeLancey JO (2005) The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 192(5):1488–1495PubMedCrossRef

Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO (2006) Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 195(1):23–28PubMedCentralPubMedCrossRef

Oberwalder M, Connor J, Wexner SD (2003) Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 90(11):1333–1337PubMedCrossRef

Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308(6933):887–991PubMedCentralPubMedCrossRef

Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal birth. N Engl J Med 329(26):1905–1911PubMedCrossRef

Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS (1999) Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum 42(12):1537–1543PubMedCrossRef

Weinstein MM, Pretorius DH, Jung SA, Nager CW, Mittal RK (2009) Transperineal three-dimensional ultrasound imaging for detection of anatomic defects in the anal sphincter complex muscles. Clin Gastroenterol Hepatol 7(2):205–211PubMedCentralPubMedCrossRef

DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, Hussain H, Umek W, Hsu Y, Ashton-Miller JA (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109(2 Pt 1):295–302PubMedCrossRef

Roos AM, Thakar R, Sultan AH (2010) Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol 36(3):368–374PubMedCrossRef

10.

Richter HE, Fielding JR, Bradley CS, Handa VL, Fine P, FitzGerald MP, Visco A, Wald A, Hakim C, Wei JT, Weber AM (2006) Pelvic floor disorders network. Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol 108(6):1394–1401PubMedCrossRef

11.

Wieczorek AP, Stankiewicz A, Santoro GA, Woźniak MM, Bogusiewicz M, Rechberger T (2011) Pelvic floor disorders: role of new ultrasonographic techniques. World J Urol 29(5):615–623PubMedCrossRef

12.

Unger CA, Weinstein MM, Pretorius DH (2011) Pelvic floor imaging. Obstet Gynecol Clin North Am 38(1):23–43, vii. ReviewPubMedCrossRef

13.

Dietz HP (2010) Pelvic floor ultrasound: a review. Am J Obstet Gynecol 202(4):321–334PubMedCrossRef

14.

Tubaro A, Koelbl H, Laterza R, Khullar V, de Nunzio C (2011) Ultrasound imaging of the pelvic floor: where are we going? Neurourol Urodyn 30(5):729–734PubMedCrossRef

15.

Valsky DV, Yagel S (2007) Three-dimensional transperineal ultrasonography of the pelvic floor: improving visualization for new clinical applications and better functional assessment. J Ultrasound Med 26(10):1373–1387, ReviewPubMed

16.

Alexander AA, Miller LS, Liu JB, Feld RI, Goldberg BB (1994) High-resolution endoluminal sonography of the anal sphincter complex. J Ultrasound Med 13(4):281–284PubMed

17.

Hall RJ, Rogers RG, Saiz L, Qualls C (2007) Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels. Int Urogynecol J Pelvic Floor Dysfunct 18(8):881–888PubMedCrossRef

18.

Roos AM, Abdool Z, Sultan AH, Thakar R (2011) The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: the PREDICT study. Clin Radiol 66(7):597–604PubMedCrossRef

19.

Lanzarone V, Dietz HP (2007) Three-dimensional ultrasound imaging of the levator hiatus in late pregnancy and associations with delivery outcomes. Aust N Z J Obstet Gynaecol 47(3):176–180PubMedCrossRef

20.

Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct 19(5):633–636PubMedCrossRef

21.

Delancey JO, Toglia MR, Perucchini D (1997) Internal and external anal sphincter anatomy as it relates to midline obstetrical lacerations. Obstet Gynecol 90(6):924–927PubMedCrossRef

22.

Lee JH, Pretorius DH, Weinstein M, Guaderrama NM, Nager CW, Mittal RK, USA (2007) Transperineal three-dimensional ultrasound in evaluating anal sphincter muscles. Ultrasound Obstet Gynecol 30(2):201–209PubMedCrossRef

23.

Huang WC, Yang SH, Yang JM (2007) Three-dimensional transperineal sonographic characteristics of the anal sphincter complex in nulliparous women. Ultrasound Obstet Gynecol 30(2):210–220PubMedCrossRef

24.

West RL, Felt-Bersma RJ, Hansen BE, Schouten WR, Kuipers EJ (2005) Volume measurements of the anal sphincter complex in healthy controls and fecal-incontinent patients with a three-dimensional reconstruction of endoanal ultrasonography images. Dis Colon Rectum 48(3):540–548PubMedCrossRef

25.

Starck M, Bohe M, Fortling B, Valentin L (2005) Endosonography of the anal sphincter in women of different ages and parity. Ultrasound Obstet Gynecol 25(2):169–1776PubMedCrossRef

26.

Rociu E, Stoker J, Eijkemans MJ, Laméris JS (2000) Normal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging. Radiology 217(2):395–401PubMedCrossRef

27.

Valsky DV, Messing B, Petkova R, Savchev S, Rosenak D, Hochner-Celnikier D, Yagel S (2007) Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal birth and following surgical repair of third-degree tears by the overlapping technique. Ultrasound Obstet Gynecol 29(2):195–204PubMedCrossRef

28.

Dobben AC, Terra MP, Deutekom M, Slors JF, Janssen LW, Bossuyt PM, Stoker J (2007) The role of endoluminal imaging in clinical outcome of overlapping anterior anal sphincter repair in patients with fecal incontinence. AJR Am J Roentgenol 189(2):W70–W77PubMedCrossRef

29.

Terra MP, Beets-Tan RG, van der Hulst VP, Deutekom M, Dijkgraaf MG, Bossuyt PM, Dobben AC, Baeten CG, Stoker J (2006) MRI in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol 187(4):991–999PubMedCrossRef

30.

Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115(8):979–984PubMedCrossRef

31.

Guise JM, Boyles SH, Osterweil P, Li H, Eden KB, Mori M (2009) Does cesarean protect against fecal incontinence in primiparous women? Int Urogynecol J Pelvic Floor Dysfunct 20(1):61–67PubMedCrossRef

Titel: Postpartum translabial 2D and 3D ultrasound measurements of the anal sphincter complex in primiparous women delivering by vaginal birth versus Cesarean delivery
verfasst von: Kate V. Meriwether
Rebecca J. Hall
Lawrence M. Leeman
Laura Migliaccio
Clifford Qualls
Rebecca G. Rogers
Publikationsdatum: 01.03.2014
Verlag: Springer London
Erschienen in: International Urogynecology Journal / Ausgabe 3/2014
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2215-7

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Postpartum translabial 2D and 3D ultrasound measurements of the anal sphincter complex in primiparous women delivering by vaginal birth versus Cesarean delivery